Volunteer Emergency-Responder Work-Absence Notice and Verification Packet - Rhode Island
VOLUNTEER EMERGENCY-RESPONDER WORK-ABSENCE NOTICE AND VERIFICATION PACKET
Rhode Island — R.I. Gen. Laws §§ 28-6.13-2 and -3
1. COVERAGE WORKSHEET
| Field | Entry |
|---|---|
| Employee | [________________________________] |
| Employer / worksite | [________________________________] |
| Scheduled report time | [__/__/____ at ________] |
| Fire or ambulance department | [________________________________] |
Responder status:
- ☐ Volunteer firefighter
- ☐ Call firefighter
- ☐ Reserve firefighter
- ☐ Permanent-intermittent firefighter
- ☐ Emergency medical technician
Compensated responder service in the preceding six months: [________] hours.
- ☐ No more than 975 hours.
- ☐ More than 975 hours or uncertain; route to counsel.
Emergency category:
- ☐ Fire
- ☐ Rescue
- ☐ Emergency medical service call
- ☐ Hazardous-materials incident
- ☐ Natural or man-made disaster
Confirm all:
- ☐ The emergency occurred outside the employee's normal working hours.
- ☐ The employee responded to, worked at, or returned from the emergency.
- ☐ The response caused failure to report at the commencement of regular working hours.
- ☐ The employee gave prompt notice and explained the reason.
2. EMPLOYEE NOTICE
Notice date and time: [__/__/____ at ________]
I promptly notify [EMPLOYER / SUPERVISOR] that I [FAILED / EXPECT TO FAIL] to report at the start of regular working hours because I was [RESPONDING TO / WORKING AT / RETURNING FROM] the emergency identified above as a volunteer member of [DEPARTMENT].
Scheduled report time: [________] Actual / expected report time: [________]
I understand that R.I. Gen. Laws § 28-6.13-3 does not require compensation for the missed normal working hours.
- ☐ Chief certification attached
- ☐ Chief certification requested and will follow
- ☐ Employer has not requested certification
Employee signature: __________________________ Date: ______________
3. CHIEF CERTIFICATION
I, [CHIEF NAME], certify that [EMPLOYEE] responded to and returned from the emergency at these times:
| Fact | Date and time |
|---|---|
| Response | [__/__/____ at ________] |
| Return from emergency | [__/__/____ at ________] |
Chief signature: __________________________ Date: ______________
Department contact: [________________________________]
4. EMPLOYER ACKNOWLEDGMENT
| Item | Entry |
|---|---|
| Prompt notice received | [________________________________] |
| Certification requested / received | [________________________________] |
| Missed work period | [________________________________] |
| Payroll treatment | [UNPAID / VOLUNTARY PTO / OTHER] |
| Attendance notation | [________________________________] |
Chapter 28-6.13 bars discharge or discipline for a covered failure to report. A violation may support immediate reinstatement, lost pay or benefits, and a Superior Court action commenced within one year.
Employer representative: ____________________ Date: ______________
5. DELIVERY LOG
| Date / time | Item | Method | Receipt / follow-up |
|---|---|---|---|
| [________] | [________________] | [________] | [________________] |
| [________] | [________________] | [________] | [________________] |
OFFICIAL SOURCES VERIFIED
About this template
- Last updated
- August 10, 2026
- Citations checked
- August 10, 2026
- Jurisdiction
- Rhode Island
- Category
- Employment & HR
Legal authority
- R.I. Gen. Laws §§ 28-6.13-2 and 28-6.13-3 (off-hours emergency-response employment protection for qualifying volunteer firefighters and EMTs; prompt notice, proof, pay, remedies, and one-year action period)
Employment documents govern the relationship between a company and its workers, from offer letters and employment agreements through handbooks, performance reviews, and separations. Done right, they set clear expectations, protect against wrongful termination and discrimination claims, and give both sides a record to rely on. Done poorly, they invite lawsuits, agency complaints, and costly disputes.
Not legal advice
This template is provided for informational purposes. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.
Checked against the law it cites
A reviewer verified this template's legal citations against the official source on August 10, 2026.
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